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Central Wisconsin Health Partnership

CCS Regional Training

Consumer-Centered Crisis PlanningWaupaca County Courthouse

Dan Naylor, MPA

White Pine Consulting Service

N3000 Rusch Road

Waupaca, WI 54981

(715) 258-5430

[email protected]

www.wicollaborative.org

Sharon Locklin and Jessica Delzer

UW Green Bay

Behavioral Health Training Partnership

2420 Nicolet Drive, RH310

Green Bay, WI 54311

(920) 465-2117

[email protected]

Joann Stephens

Stable Life

(608) 296-4634

[email protected]

Workshop Objectives

� Enhance knowledge of the importance of partnerships in collaborative systems of care during the crisis planning process

� Review process for developing a functional plan for crisis for consumers involved in CCS, emphasizing meaningful outcomes

� Demonstrate the development of a person-centered crisis plan that meets the requirements of DHS 34

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Crisis and CCS

� Crisis is driven by DHS 34

� CCS is driven by DHS 36

� DHS 36 and Crisis Planning

– CCS Service Plan (DHS 36.07)

– Provider Orientation and Training (DHS 36.12)

– Consumer Application Process (DHS 36.13)

– CCS Consumer Assessment (DHS 36.16)

– The Recovery Team (DHS 36.16 (7))

� CCS can coordinate crisis services, but cannot

actually provide crisis services

CCS Tools

� Consumer-Centered Approach

� Functional Eligibility Screen

� Comprehensive CCS Assessment

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The Importance of Partnership

� No single agency has the staff or resources to serve all individuals with complex needs. Drawing on the expertise and energy of many agencies and individuals working together can increase resources.

� Successfully meeting the needs of consumers and team partners, requires a close collaborative relationship with the consumer. The consumer must be actively involved in the planning, implementation, and evaluation of services.

Absence of a Plan for Crisis

� People are reactive rather than proactive

� People respond to crisis situations without

knowledge of the individual, and of what’s

worked and what hasn’t worked in the past

� In the absence of information about the

individual, best efforts may intensify the crisis

situation

“A crisis occurs when adults don’t know what to do.” – Carl Shick

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Crisis Prevention Planning

� Distinguish between Crisis issues and “Plan of Care”

issues

� Some crises will be prevented as a result of

collaborative planning based on identified needs and

strengths

� Accurate information regarding early warning signs of a

crisis can allow for timely and appropriate response

� For staff, less time is spent managing crises and more

time on activities that promote meaningful long-term

outcomes for consumers.

Development of a Plan for Crisis

� Expect that an individual with multiple needs living in the

community will experience crisis.

� Consider the most challenging act(s) that could happen

� Review historical strength-based information regarding

strategies that have worked

� Pre-plan interventions with people and/or agencies who may be

involved in the case of an escalation or crisis

� Develop a protocol of who will be notified, in what time frame,

including responsibilities and communication procedures

� Establish a “blame free” time in which team members cannot

fault each other for the crisis

� Develop a process for evaluating the crisis plan’s use within two

weeks of the event.

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Crisis Continuum

UWGB Behavioral Health Training Partnership

CCS Assessment and Planning Processes

CCS Planning for Crisis

Stages of the Crisis Continuum

Stable (baseline) – Individual is functioning well and our response is preventative

– Assessing the strengths and needs

– Reinforcing the positives

– Positive interaction and engagement

– Identify early intervention strategies

– Begin the development of a team

– Connecting with supports

– Develop a Crisis Plan when the consumer is stable

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Escalation – Increased anxiety or agitation

– Continued engagement

– Removal of environmental stressors,

– Soothing techniques

– Active listening and problem solving

– Reinforcing strengths

– Stress management skills

– Teaching replacement behaviors

– Provide access to resources

– Ongoing assessment and prevention planning


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Acute – Individual is overwhelmed and out of control. There may be issues of self harm or harm to others. Law enforcement may be involved.

– De-escalation techniques

– Risk assessment and safety planning

– Offering choices

– Developing a response plan


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Acute (cont’)

– Close supervision and monitoring

– Contact support persons identified in the crisis

plan and/or contact law enforcement if imminent

risk

– Referral to diversion bed or hospital if necessary

– Planning with the team


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� Stabilization – when the person is returning to pre-crisis (stable) state

– Continued de-escalation and stabilization

– De-briefing and re-engagement,

– Continued monitoring and support

– Re-assessment of crisis plan and adjustment as needed

– Crisis prevention strategies


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Person-Centered Planning

� Consumer is actively involved

� Need to prep the consumer for this—Peer

Specialists, WRAP Plans can help

� Need to have a trauma-informed approach

Trauma

� Extreme stress that overwhelms a person’s ability to

cope and results in feeling vulnerable, helpless and

afraid

� Often interferes with relationships and fundamental

beliefs about oneself, others and one’s place in the

world

� May be witnessed or experienced directly

Source: Shift Your Perspective – Trauma Informed Care; Elizabeth Hudson, Wisconsin

Department of Health Services;

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Historical Trauma

� Collective and cumulative emotional and

psychological wounding across generations,

emanating from massive group trauma.

� Generates survivor guilt, depression, low self-

esteem, psychic numbing, anger, and physical

symptoms.

� Creates the community’s “soul mood” (Maria Yellow Horse

Brave Heart, PhD; Director of Native American and Disparities

Research, Center for Rural and Community Behavioral Health)

Source: Shift Your Perspective – Trauma Informed Care; Elizabeth Hudson, Wisconsin

Department of Health Services;

Triggers

� Something that sets off an action, process or series of events (such as fear, panic, upset, or agitation).

� Triggers can be internal and/or external

� Key triggers include:

– Lack of power or control

– Unexpected change

– Feeling threatened or attacked

– Feeling vulnerable or frightened

– Feeling shame

– Positive feelings or intimacy

Sources:

• Shift Your Perspective – Trauma Informed Care; Elizabeth Hudson, Wisconsin Department

of Health Services

• The Emerging Science of Trauma Informed Care – Kevin Ann Huckshorn, 2004

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Re-enactment Behaviors

� Behaviors that seem out of place—

seem to come out of nowhere

� Re-enacting some inappropriate

behaviors they have been exposed to

� Survival mechanism

National Childhood Traumatic Stress Network:

Trauma Curriculum

Creating Trauma-Sensitive Services

to Improve Well-Being

� Some have been traumatized by directly or vicariously experiencing violence, homelessness, loss (or fear of loss) of loved ones, or other kinds of devastating experiences.

� Trauma can interfere with learning, regulating emotions, and normal development; or can lead to positive outcomes.

� Providers can be more sensitive to consumer needs so they can experience success and social acceptance.

� Providers can promote the development of healthy coping and resilience.

Kathryn Bush, Ph.D., School Psychology Consultant, Wisconsin Department of Public Instruction

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Early Warning Signs

“What might you or others notice or what do you feel just before losing control?”

Examples may include:

– Clenching teeth

– Restlessness

– Crying

– Giggling

– Pacing

– Heavy breathing

– Swearing

– Others…

Source: The Emerging Science of Trauma Informed Care – Kevin Ann Huckshorn, 2004

Brainstorm Strategies

� Consider strategies or interventions that have worked in the past

– Experiences of the consumer and team members

– What are some things that help you calm down when you start to get upset?

� Consider strengths of the consumer, supports, team, and community

Source: The Emerging Science of Trauma Informed Care – Kevin Ann Huckshorn, 2004

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Group Activity

� Please read the assigned scenario

(either HO #4 or HO #5)

� Take out Handout #6 (Crisis Plan

Template)

� Complete the Potential Problems

section on the bottom of Page 2 for the

scenario

Potential Strategies

� Emotional Regulation Skills

– Identify emotion and teach opposite action

– Time out or away from situation

– Breathing

– Mindfulness

– Changing thoughts or interpretation of the

situation

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Potential Strategies (cont).

� Crisis Survival Skills

– Change body temperature by using ice

cold water on your face or intense aerobics

to heat up

– Distraction—focus on something else

– Self-soothing using senses—listen to

music, eat something you love, aroma

therapy, touch something soothing

Potential Strategies (cont.)

� Identify supportive persons

� Identify safe places

� Prepare the consumer for transitions or

things that are out of routine

� Use imagery

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Group Activity

� Going back to Scenario

� Take 2 items from Potential Problems

list on Page 2

� Put them into the grid on Page 3 under

the corresponding domain

� Develop a strategy for preventing the

problem

Developing the Document

� This template meets the criteria for DHS 34

� It has all the demographic information

required

� It asks you to list the interventions that both

prevent crisis and that need to be

implemented at the time of escalation

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Creating Plans for Crisis:

The Final Details

� Per DHS 34, Crisis Plans need to be signed

off by a Psychologist or Psychiatrist within 2

weeks of development

� They must be reviewed at least every 6

months or whenever they are updated

� Important to get signatures from individuals

and agencies involved in the plan’s

development and to distribute the plan to all

involved

Group Activity

� Complete the Interventions section on

Page 3 of the template for your

assigned scenario

� Remember to go from least to most

restrictive

� Share with larger group

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Video Link

White Pine Consulting Service, Inc.

Crisis Intervention Team Training for Law Enforcement

Core Outcomes

� Reduce incidents of injury to officers and others.

� Reduce repeat patrol calls for service to individuals with mental health needs.

� Enhance the working relationship of patrol officers with mental health providers.

� Increase involvement of family and friends of individuals with mental health needs as a crisis response alternative.

� Increase awareness and availability of community resources to individuals with mental health needs and their families, which may assist in recovery.

Sgt. John Wallschlaeger, Appleton Police Department, WI

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www.cwhpartnership.org

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